#205 Nutrition Studies, Coffee and the CRAVE Trial: Beyond Journal Club with the NEJM Group

Can you distinguish benign eosinophilia from a sign of serious disease, and know exactly when to act at the bedside?In this high-yield episode, test your clinical reasoning as we tackle:When eosinophilia becomes dangerous and why it mattersHow to distinguish if its from atopy vs. systemic diseaseWhich medications to stop (and which to watch)How travel, diet, and exposure history shape your workupWhen to suspect malignancy before giving steroids🔹Transcript and Shownotes: 02:34 | Why Do We Care About Eosinophilia? (Pearl 1)10:24 | Atopy and Eosinophilia (Pearl 2)18:57 | Drugs and Eosinophilia (Pearl 3)27:29 | ID and Eosinophilia (Pearl 4)33:54 | Pearl 5: Eosinophilia, Steroids, and Neoplasms (Pearl 5)Tags: CoreIM, Internal Medicine, Medical Education, Eosinophilia, Hypereosinophilia, Allergy Immunology, Hematology, Pulmonology, Parasitic Infections, AtopyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Is coffee helping or harming our patients’ hearts?In this Beyond Journal Club, we unpack the CRAVE trial and use it as a lens to answer a bigger question:How should clinicians interpret nutrition research, especially when it feels inconsistent or hard to trust?Listen for a concise, practical framework you can use the next time a patient asks about coffee, diet, or lifestyle.🔹Sponsor: Oakstone CMEUse the code "CORE325" for 25% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and Show notes00:00 | Challenges of interpreting nutritional research.02:22 | Best practices for evaluating studies in nutrition. 12:35 | Delve into the CRAVE trial as an example of critically appraising nutritional investigations.26:41 | Applying this to clinical practice for your patients.Tags: IMCore, Internal Medicine, Medical Education, Epidemiology, Diet and LifestyleFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why can these infections be tricky? How to diagnose osteomyelitis at the bedside? Do we always need IV vs oral antibiotics? And the best for last: Simple, practical wound care strategies for medical students, residents, and clinicians who want a clear, usable approach..🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com🔹Transcript and Shownotes:02:15 | Pearl 1: Pathophysiology08:20 | Pearl 2: Diagnosis16:35 | Pearl 3: Treatment20:35 | Pearl 4: Antibiotics27:39 | Pearl 5: Wound CareTags: CoreIM, Internal Medicine, Medical Education, Diabetic Foot Infections, Osteomyelitis, Foot Ulcer, Wound CareFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?🔹Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/See here for Neph Madness details See here for the POCUS region of NephMaddnessVOTE here to build your bracket!🔹Transcript and Shownotes:00:52 | What is NephMadness?02:19 | Detecting post-renal obstruction in a patient who reported normal urination11:26 | POCUS for discharge or continue diurese 17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis lineAlong the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUSFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Most clinicians see dementia medications on the med rec, but many of us aren’t sure how much they actually help. In this episode we break down donepezil, memantine, and the new anti-amyloid drugs, and when to stop them.• Do cholinesterase inhibitors really work?• What should clinicians know about lecanemab and donanemab before referring patients?• How much benefit should we expect and for how long?• When should you deprescribe dementia medications?🔹Sponsor: Caraway’s cookware set is a favorite for a reason.For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.🔹Transcript and Shownotes02:27 | Deep Dive 1: How do we deliver the news of a diagnosis of dementia?09:41 | Deep Dive 2: Prescribing medications for cognitive decline29:30 | Deep Dive 3: Patient-centered management for a patient with cognitive decline35:46 | Deep Dive 4: Planning for an uncertain futureTags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Cognitive decline is tough for all parties. What are the high-yield questions to ask? What should you add to your one-liner? When do you stop using MOCA and try to clearly describe their functional status? Do all patients with cognitive decline need an MRI?🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com🔹Transcript & Shownotes:01:12 | Cognitive Concerns During a Routine Follow-Up03:41 | Deep Dive 1: How do you pivot when you recognize unexpected memory issues?15:08 | Deep Dive 2: What tools should we use to characterize and stage cognitive decline?31:09 | Deep Dive 3: How do we determine the etiology of cognitive decline?Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

From metformin to basal insulin to overlooked older medications, this episode reviews the T2D medication toolkit clinicians use every day. We then dive into new evidence on once-weekly insulin to help you individualize therapy while reducing treatment burden.🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/🔹Transcript and Shownotes:00.58 | Insulin Hx & Types06:00 | Indications for Insulin and the Burden on Patients08:26 | What is the QWINT-1 Trial?16:18 | DiscussionTags: CoreIM, Internal Medicine, Evidence-Based Medicine, Insulin Resistance, Clinical Reasoning, Hospital Medicine, Medical Education, Endocrine, EndocrinologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Is patient confidentiality absolute or conditional? When does protecting privacy put others at risk? Can you follow a former patient in the EHR for learning? Should you post a compelling case online even if it’s “de-identified”? And when does the law force you to betray patient trust? In this episode of At the Bedside, learn how clinicians should act when ethics, law, and trust collide.🔹 Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com🔹Transcript and Shownotes:03:51 | What is the difference between Privacy and Confidentiality?05:50 | Guidelines and laws10:06 | Limits/appropriate breaches (competing principles/obligations) 22:03 | Privacy vs education35:34 | ConclusionFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Baby alligators  - those betrayals of purpose , or, death by a thousand paper cuts !Check out our latest episode, where Dr. Eileen Barrett walks us through how to tackle baby alligators with:Regulated curiosityStrategic empathySmall, well-chosen moves......and change that is big enough to matter, and small enough to win!🔹 Sponsor: Caraway’s cookware set is a favorite for a reason.For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.🔹 Transcript & Shownotes00:00 | What are “baby alligators” in medicine?02:24 | Rifaximin & Workflow Fixes14:17 | Verbal Orders Policy18:39 | Micro Skills for Change25:12 | Key Takeaways#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QIFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Gray zones of VTE management! How to approach anticoagulation duration in unprovoked, provoked-irreversible, and provoked-reversible clots?When dose-reduced DOACs make sense for long-term secondary prevention? What truly constitutes DOAC failure? We also devle into how APLAS a critical do-not-miss diagnosis that changes management entirely.🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/🔹 Transcript & Shownotes(2:56) - (13:15) | PEARL 1: Managing clots in the “unprovoked”/provoked-irreversible patient(13:21) - (18:10) | PEARL 2: Managing provoked, “reversible” clots(18:14) - (25:14) | PEARL 3: DOAC failure: time to step it up?(25:20) - (37:25) | PEARL 4: APLAS: the exception to everythingTags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Quince: https://quince.com/coreim* Use code FIGSRX for 20% off: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy